Learning Objectives

  • Demonstrate an increase in your knowledge of clinical medicine.
  • Evaluate the appropriateness of clinical information as it applies to the care of your patients.
  • Demonstrate an improvement in your ability to make decisions that provide safe and effective medical care.
  • Recognize areas of personal strength and areas for growth in clinical knowledge.

Intended Audience

Physician assistants and physician assistant students who are seeking to maintain and augment their knowledge and/or who are preparing for their initial board certification or recertification.

AAPA Self-Assessment CME Credit

AAPA Category 1 Self-Assessment CMEThis activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 225 AAPA Category 1 Self-Assessment CME credits. PAs should only claim credit commensurate with the extent of their participation. Approval is valid from 6/1/2023 to 6/1/2024. AAPA reference number: 209296.

For NCCPA certification maintenance ONLY: NCCPA will now apply an additional 50 percent weighting when these self-assessment credits are logged for NCCPA certification maintenance purposes. PAs should log up to a maximum of 225 AAPA Category 1 Self-Assessment CME credits, as the additional weighting will be automatically applied by NCCPA.

You will receive one credit for every ten questions you answer correctly.

CME Disclosure

All persons who may impact the content of a CME activity, including faculty and planners, are required to fully disclose current and recent financial relationships with commercial interests. A conflict of interest may be considered to exist if such a person has financial relationships with the grantor or any non-eligible entities (commercial interests) that may have a direct impact on the content of the program. Financial relationship is defined as being a shareholder, consultant, grant recipient, research participant, employee, and/or recipient of other financial or material support. Recent is defined as within the past 24 months.

MMS Disclosure Policy

The Massachusetts Medical Society (MMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) and must ensure independence, balance, and scientific rigor in its accredited continuing education activities. All individuals in control of the content for an MMS accredited continuing education activity must disclose all financial relationships with ineligible companies.

Individual Disclosures

Below are all relevant financial relationships reported by NEJM Knowledge+ contributors during the past 3 years.

Vaneeta Bamba, MD

2021Novo Nordisk, Growth Advisory Board for Genetic Short Stature, discontinued Nov 2020
2022Nothing disclosed
2023Nothing disclosed

Ethan Brown, MD

2021Rune Labs, consultant, discontinued Apr 2019
2022Rune Labs, consultant
2023Nothing disclosed

Steven Chen, MD

2022Pfizer, advisory board member, discontinued May 2021
Novartis, advisory board member, discontinued Dec 2021

Ezra M. Cohen, MD

2021Cornerstone Research Group, consultant
2022Nothing disclosed
2023Presidio, scientific board member

Nathan Connell, MD

2021Nothing disclosed
2022Takeda Pharmaceutical, consultant
2023Takeda Pharmaceutical, consultant
Octapharma, honoraria
Genentech, advisory board member
Doximity, equity

Areeg H. El-Gharbawy, MD

2021Ultragenyx, principal investigator for a clinical trial
Ultragenyx, advisory board member
Amicus, advisory board member

Rajesh T. Gandhi, MD

2021Merck, scientific advisory board
2022Nothing disclosed
2023Nothing disclosed

Glenn J. Hanna, MD


Actuate Therapeutics, grant/funding

Bicara, consultant/advisory board

Bicara, grant/funding

Boxer Capital, consultant

Bristol Myers Squibb, grant/funding

Bristol Myers Squibb, consultant

Coherus, consultant

Elevar, consultant/advisory board

Exicure, grant/funding, discontinued Jan 2022

Exicure, consultant/advisory board

Gateway for Cancer Research, grant/funding

Genentech, grant/funding

General Catalyst, consultant

GlaxoSmithKline, grant/funding

ImmunityBio, grant/funding

Kartos Therapeutics, grant/funding

Kite Pharma, grant/funding, discontinued Jun 2022

KSQ Therapeutics, consultant

KSQ Therapeutics, grant/funding

Kura Oncology, consultant/advisory board

Kura Oncology, grant/funding

Merck, consultant/advisory board

Naveris, consultant/advisory board

Prelude, consultant/advisory board

Rain Therapeutics, consultant, discontinued Nov 2021

Regeneron, consultant/advisory board

Regeneron, grant/funding

Remix Therapeutics, consultant/advisory board

Repertoire, grant/funding

Sanofi Genzyme, advisory board, discontinued Nov 2021

Sanofi Genzyme, grant/funding

Secura Bio, grant/funding

V Foundation, grant/funding, discontinued Jun 2022

Jonathan S. Hausmann, MD


Pfizer, consultant, discontinued Dec 2020

Biogen, consultant, discontinued Dec 2020

Novartis, consultant


Pfizer, consultant, discontinued Dec 2020

Biogen, consultant, discontinued Dec 2020

Novartis, consultant

2023Fresenius Kabi, consultant
Novartis, consultant

Brian C. Healy, MD


Analysis Group, grant support
Celgene (Bristol Myers Squibb), grant support
Verily, grant support
Novartis, grant support
Merck Serono, grant support
Genzyme, grant support


Analysis Group, research support to institution, discontinued Nov 2020
Celgene (Bristol Myers Squibb), research support to institution, discontinued Nov 2020
Novartis, research support


Novartis, research support

Koyal Jain, MD, MPH


PI for Kaneka study and Visterra study

Mihir M. Kamdar, MD

2021Amorsa Therapeutics, scientific advisory board, stockholder
Medtronic, consultant, fees
Fern Health, consultant, fees
2022Nothing disclosed
2023Elevate, cofounder and chief medical officer
Fern Health, medical advisor

Ruslan Korets, MD

2021Boston Scientific, consultant
2022Boston Scientific, consultant
2023Boston Scientific, consultant

Lekha M. Rao, MD

2023Epigenyx Therapeutics, consultant
UCB, principal investigator for a clinical trial
Eisai, principal investigator for a clinical trial

Leigh C. Reardon, MD


Janssen, speaker
CareDx, participant in advisory board discussion, discontinued Dec 2020

2022Janssen, advisory committee
2023Janssen, consultant

Eric Roeland, MD

2023Napo Pharmaceuticals, scientific advisory board
Actimed Therapeutics, scientific advisory board
Meter Health, scientific advisory board
Veloxis Pharmaceuticals, consultant
Aileron Therapeutics, consultant
BYOMass, consultant
Takeda, advisory board
Enzychem Lifesciences Pharmaceutical Company, data safety monitoring board

Deborah R. Stein, MD

2021Nothing disclosed
2022Nothing disclosed
2023Horizon, consultant
Alexion, consultant

Taher S. Valika, MD

2021Save My Scope Inc, chief medical officer

Ruth Ann Vleugels, MD, MPH, MBA

2021Pfizer, principal investigator for a clinical trial

Raymond Y. Wang, MD


Biomarin Pharmaceutical, speaking engagement, discontinued Jul 2019

Biomarin Pharmaceutical, advisory committee, discontinued Sep 2019

RegenxBio, advisory committee, discontinued May 2020

Takeda Pharmaceutical, advisory committee, discontinued Aug 2020

Ultragenyx Pharmaceutical, webinar, discontinued Nov 2020

Inventiva Pharmaceutical, advisory committee, discontinued Dec 2020

Neurogene, advisory committee, discontinued Nov 2020

Denali Therapeutics, drug monitoring committee


Biomarin, ad hoc advisory board, discontinued Oct 2021

Orphazyme, ad hoc FDA advisory meeting, discontinued Oct 2021

Sio Gene Therapies, consultant, discontinued Nov 2021

Sio Gene Therapies, ad hoc advisory board, discontinued Aug 2021

Inventiva Pharmaceutical, ad hoc advisory board, discontinued Jul 2021

Takeda Pharmaceutical, ad hoc advisory board, discontinued Mar 2021

Ultragenyx, speaker, discontinued Nov 2020

Neurogene, ad hoc advisory board, discontinued Oct 2020

Regenxbio, ad hoc advisory board, discontinued Apr 2020

2023RegenxBio, consultant
Takeda Pharmaceutical, advisory committee, discontinued 2022
Denali, drug safety monitoring board

Sharmeel K. Wasan, MD

2021Pfizer, grant support
2022Nothing disclosed
2023Nothing disclosed

All relevant financial relationships have been mitigated prior to the beginning of this activity in accordance with ACCME and MMS policies. All other individuals in control of the content have reported no relevant financial relationships with ineligible companies for this activity. The complete list of contributors can be found here.

Disclosure of Commercial Support

No commercial support was received for this activity.

Medium or Combination of Media Used

This is an adaptive self-assessment tool designed to adjust to the learner’s strengths and areas for growth, and can be accessed from a desktop, laptop, tablet, or smartphone. Learners choose the subspecialty area and are presented with a sequence of questions. After each question is answered, the user is provided with the key learning point, detailed feedback that discusses the correct answer as well as each of the wrong answers, and citations to relevant articles.

Estimated Time to Complete the Educational Activity

One hour for every 10 questions answered correctly.


Each clinical vignette includes citations and references.

Hardware/Software Requirements


In general, we support the two latest versions of major browsers:

  • Edge (Recommended for best performance)
  • Chrome (Recommended for best performance)
  • Firefox
  • Safari

Systems Minimum Requirements

  • Screen Size: 4.5″+ (mobile)
  • Some content types might not work on small screens
  • Win10+ with 4GB+ RAM (8GB+ recommended)
  • macOS 11+ with 4GB+ RAM (6GB+ recommended
  • Android 10+ with 2GB+ RAM
  • iOS 12+ with 2GB+ RAM (Devices from 2019+ recommended)
  • Internet bandwidth: 1Mbit/s+ bandwidth (10MBit/s recommended, depends on content type)

Contact Information

For all questions and comments, please contact NEJM Knowledge+ by email at knowledgeplussupport@nejm.org or call toll-free +1-855-318-9303 (within the USA and Canada) or +1-781-434-7998.

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